hepatitis

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Inflammation of the liver, caused by infectious or toxic agents and characterized by jaundice, fever, liver enlargement, and abdominal pain.

An inflammation of the liver caused by a number of etiologic agents, including viruses, bacteria, fungi, parasites, drugs, and chemicals. The most common infectious hepatitis is of viral etiology. All types of hepatitis are characterized by distortion of the normal hepatic lobular architecture due to varying degrees of necrosis of individual liver cells or groups of liver cells, acute and chronic inflammation, and Kupffer cell enlargement and proliferation. There is usually some degree of disruption of normal bile flow, which causes jaundice. The severity of the disease is highly variable and often unpredictable. See also Liver.

A frequently occurring form of hepatitis is caused by excessive ethyl alcohol intake and is referred to as alcoholic hepatitis. It usually occurs in chronic alcoholics and is characterized by fever, high white blood cell count, and jaundice. Some drugs are capable of damaging the liver and can occasionally cause enough damage to produce clinical signs and symptoms. Among these drugs are tetracycline, methotrexate, anabolic and contraceptive steroids, phenacetin, halothane, chlorpromazine, and phenylbutazone.

Clinical features of hepatitis include malaise, fever, jaundice, and serum chemical tests revealing evidence of abnormal liver function. In most mild cases of hepatitis, treatment consists of bedrest and analgesic drugs. In those individuals who develop a great deal of liver cell necrosis and subsequently progress into a condition known as hepatic encephalopathy, exchange blood transfusions are often used. This is done with the hope of removing or diluting the toxic chemicals thought to be the cause of this condition. Chronic hepatitis is a condition defined clinically by evidence of liver disease for at least 6 consecutive months. See also Alcoholism; Liver disorders.

Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). The prevalence of HCV infection worldwide is 3% (170 million people), with infection rates in North America ranging from 1 to 2% of the population. A simulation analysis estimated that in the period from 1998 to 2008 there will be an increase of 92% in the incidence of cirrhosis of the liver, resulting in a 126% increase in the incidence of liver, failures and a 102% increase in the incidence of hepatocellular carcinoma (HCC), all attributed to HCV.

Hepatitis C virus can be transmitted only by blood-to-blood contact. With the institution of screening of blood, intravenous drug use has become the major source of transmission in North America. Approximately 89% of people who use intravenous drugs for one year become infected with HCV.

Management strategies can be divided into three main areas: surveillance of patients with chronic HCV infection who have not developed cirrhosis; surveillance of patients with established cirrhosis; and strategies to eradicate HCV.

Inflammatory liver disease, characterized by jaundice, abdominal pain, and anorexia. May be due to bacterial or viral infection, alcohol abuse, or various toxins. Treatment is usually conservative, with a very low fat diet (secretion of bile is impaired) and complete abstinence from alcohol.

Even after recovery, people may continue to be carriers of the virus, especially for hepatitis B and C, which are transmitted through blood and other body fluids. Liver cancer and cirrhosis are more common among people who have suffered from hepatitis B or C.

An inflammation of the liver.

Definition

Hepatitis is inflammation of the liver. Infectious or viral hepatitis is caused by a viral infection. The three most common forms of viral hepatitis recognized to cause liver disease are hepatitis A, hepatitis B, and hepatitis C (previously called hepatitis non-A, non-B). Other recognized types of hepatitis are hepatitis D, hepatitis E, and hepatitis G.

Description

Hepatitis a

Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). It is usually not very severe, generally starting within two to six weeks after contact with the virus, and lasting no longer than two months.

Hepatitis A is commonly known as infectious hepatitis because it spreads relatively easily from those infected to their close contacts. Once the infection ends, there is no lasting, chronic phase of illness. However, it is not uncommon to have a second episode of symptoms about a month after the first (a relapse).

Epidemics of HAV infection can infect dozens and even hundreds of persons. Major outbreaks of hepatitis A have been linked to infected food handlers contaminating prepared foods. Many types of food also can be infected by sewage containing HAV, and shellfish are a common culprit.

Certain groups have an increased risk of contracting hepatitis A. These include:

• children and employees at daycare centers
• individuals living in crowded and/or unsanitary conditions
• sexually active individuals
• tourists visiting an area where hepatitis A is common

Hepatitis B

More than 300 million people throughout the world are infected by the hepatitis B virus (HBV). Hepatitis B occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most frequent chronic infectious diseases worldwide. Commonly called "serum hepatitis," hepatitis B ranges from mild to very severe. Some people who are infected by HBV develop no symptoms, but they may carry HBV in their blood and pass the infection on to others. In its chronic form, HBV infection may destroy the liver through a scarring process called cirrhosis.

When a person is infected by HBV, the virus enters the bloodstream and body fluids, and is able to pass through tiny breaks in the skin, mouth, or the genital area. This infection can occur during birth, when a mother with hepatitis B may pass HBV on to her infant. The virus also may be transmitted through contaminated needles and through unprotected sex with an HBV infected individual. Casual contact cannot transmit hepatitis B.

Hepatitis C

Hepatitis C, or HCV, causes a rapidly developing and often long-lasting disease. Spread mainly by contact with infected blood, HCV is the major cause of "transfusion hepatitis," which can develop in patients who are given blood, although, donated blood is regularly tested for hepatitis C as of the early 2000s. The existence of a third hepatitis virus (in addition to the A and B viruses) became clear in 1974, although HCV was first identified in 1989.

Hepatitis C is generally mild in its early, acute stage, but it is much more likely to produce chronic liver disease than hepatitis B. About two of every three persons who are infected by HCV may continue to have the virus in their blood and become carriers who can transmit the infection to others.

The most common way of transmitting hepatitis C is when blood containing the virus enters another person's bloodstream through a break in the skin or the mucosa (inner lining) of the mouth or genitals. HCV may be passed from an infected mother to the infant she is carrying (however, the risk of infection from breast milk is very low). It also can be spread through sexual intercourse, especially if one partner is acutely infected at the time.

Hepatitis D

Hepatitis D (or delta), occurs only in patients who also are infected by the hepatitis B virus. Infection by the hepatitis delta virus (HDV) either occurs at the same time as hepatitis B, or develops later when infection by HBV has entered the chronic stage.

Delta hepatitis can be quite severe, but is seen only in patients already infected with HBV. In the late 1970s Italian physicians discovered that some patients with hepatitis B had another type of infectious agent in their liver cells. Later the new virus, HDV, was confirmed by experimentally infecting chimpanzees. When both viruses are present, acute infection tends to be more serious. Furthermore, patients with both infections are more likely to develop chronic liver disease than those with HBV alone, and, when it occurs, it is more severe.

Hepatitis E

Hepatitis E also is known as epidemic non-A, non-B hepatitis. Like hepatitis A, it is an acute and short-lived illness that sometimes can cause liver failure. HEV, discovered in 1987, is spread by the fecal-oral route. It is present in countries in which human waste has contaminated the drinking water supply. Large outbreaks (epidemics) have occurred in Asian and South American countries where there is poor sanitation. In the United States and Canada no outbreaks have been reported, but persons traveling to a region where it is present may return with HEV.

Hepatitis G

HGV, also called hepatitis GB virus, was first described in early 1996. Little is known about the frequency of HGV infection, the nature of the illness, or how to prevent it. What is known is that transfused blood containing HGV has caused some cases of hepatitis. For this reason, patients with hemophilia and other bleeding conditions who require large amounts of blood or blood products are at risk of constructing hepatitis G. HGV has been identified in 1–2% of blood donors in the United States. Also at risk are patients with kidney disease who undergo hemodialysis treatments, and those who inject intravenous drugs. It is possible that an infected mother can pass on the virus to her newborn infant, or that sexual transmission can occur.

Often patients with hepatitis G are infected at the same time by the hepatitis B or C virus, or both. In about three of every thousand patients with acute viral hepatitis, HGV is the only virus present. There is some indication that patients with hepatitis G may continue to carry the virus in their blood for many years, and so might be a source of infection for others.

Causes & Symptoms

Hepatitis a

The time between exposure to HAV and the onset of symptoms ranges from two to seven weeks and averages about one month. The virus is passed in the feces, especially late in the incubation period, before symptoms first appear. The virus can live for several hours on the skin surface, and during this time may be transmitted to others. Infected persons are most contagious starting about a week before symptoms develop, and remain contagious until the time jaundice (yellowing of the skin and/or eyes) is noted.

Often the first symptoms to appear are fatigue, muscle and joint aches, nausea, and a loss of appetite. Lowgrade fever is common, and the liver often enlarges, causing pain or tenderness in the upper right part of the abdomen. Jaundice then develops, typically lasting seven to ten days.

Hepatitis B

In the United States, a majority of acute HBV infections occur in teenagers and young adults. Half of these youth never develop symptoms, and only about 20% of infected patients develop severe symptoms and jaundice. The remaining 30% of patients have only flu-like symptoms and will probably not even be diagnosed as having hepatitis unless certain tests are done. Acute hepatitis B is characterized by loss of appetite, nausea, and pain or tenderness in the right upper part of the abdomen. Compared to patients with hepatitis A or C, those with HBV infection require more bed rest.

An HBV infection lasting longer than six months is said to be chronic. After this time it is much less likely for the infection to disappear. Not all carriers of the virus develop chronic liver disease; in fact, most have no symptoms. However, about one in every four HBV carriers develop cirrhosis. Patients are also likely to have an enlarged liver and spleen. The most serious complication of chronic HBV infection is liver cancer.

Hepatitis C

More than half of all patients who develop hepatitis C have no symptoms or signs of liver disease. Some, however, may have a minor illness with flu-like symptoms. About one in four patients with hepatitis C will develop jaundice, and some patients lose their appetite and frequently feel tired. Patients also may experience nausea.

In most patients, HCV can still be found in the blood six months after the start of acute infection, and these patients are considered carriers. If the virus persists for one year, it is unlikely to disappear completely. About 20% of chronic carriers develop cirrhosis (scarring) of the liver when the virus damages or destroys large numbers of liver cells, which are then replaced by scar tissue. Cirrhosis may develop only after a long period of time—as long as 20 years—has passed. Many patients will not develop cirrhosis and instead have a mild, chronic form of infection called chronic persistent hepatitis.

Hepatitis D

The delta virus is a small and incomplete viral particle. Perhaps this small size is why it cannot cause infection on its own. Its companion virus, HBV, actually forms a covering over the HDV particle. In chronically ill patients (those whose virus persists longer than six months), cirrhosis typically occurs.

When HBV and HDV infections develop at the same time—a condition called coinfection—recovery is the rule. Only 2–5% of patients become chronic carriers (the virus remains in their blood more than six months after infection). It may be that HDV actually keeps HBV from reproducing as rapidly as it would if it were alone, making chronic infection less likely.

When HBV infection occurs first and is followed by HDV infection, the condition is called superinfection. Between one-half and two-thirds of patients with superinfection develop severe acute hepatitis. Once the liver cells contain large numbers of HBV viruses, HDV tends to reproduce more actively. Massive infection and liver failure are more common in superinfection. The risk of liver cancer, however, is no greater than from hepatitis B alone.

As with other forms of hepatitis, the earliest symptoms are nausea, loss of appetite, joint pains, and fatigue. There may be fever and an enlarged liver may cause discomfort or pain in the right upper part of the abdomen. Jaundice may develop later.

Hepatitis E

There are at least two strains of HEV, one found in Asia and another in Mexico. The virus may start dividing in the gastrointestinal tract, but it grows mostly in the liver. After an incubation period of two to eight weeks, infected persons develop jaundice, fever, nausea, a loss of appetite, and discomfort or pain in the right upper part of the abdomen. Most often the illness is mild and disappears within a few weeks with no lasting effects.

Hepatitis E never becomes a chronic illness, but on rare occasions the acute illness damages and destroys so many liver cells that the liver can no longer function. This is called fulminant liver failure, and may end in death. The great majority of patients who recover from acute infection do not continue to carry HEV and cannot pass the infection on to others.

Hepatitis G

Some researchers believe that there may be a group of GB viruses, rather than just one. Others remain doubtful that HGV actually causes illness. If it does, the type of acute or chronic illness that results is not clear. When diagnosed, acute HGV infection has usually been mild and brief. There is no evidence of serious complications, but it is possible that, like other hepatitis viruses, HGV can cause severe liver damage resulting in liver failure. The virus has been identified in as many as 20% of patients with longlasting viral hepatitis, some of whom also have hepatitis C.

Diagnosis

A health care professional will conduct a thorough medical history and physical examination of the patient when hepatitis is suspected. Blood tests for specific antigens and antibodies that are present in the different subtypes of hepatitis will confirm the diagnosis, although these tests cannot detect all types of hepatitis. Liver function tests that measure enzyme levels may also be performed.

Treatment

Once symptoms appear, no antibiotics or other medicines will shorten the course of infectious hepatitis. Patients should rest in bed as needed, follow a healthy diet, and avoid drinking alcohol or taking any medications that could further damage the liver. Any medication that can cause liver damage should be avoided, and non-critical surgery should be postponed.

An herbalist or naturopathic health care professional may recommend a preparation of milk thistle (Silybum marianum) for the treatment of hepatitis. Milk thistle is thought to promote the growth of new liver cells, and to prevent toxins from penetrating through healthy liver cells by binding itself to the cell membranes. It is frequently prescribed by herbalists for the treatment of cirrhosis, hepatitis, and other liver disorders. A large controlled trial sponsored by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institutes of health (NIH) on milk thistle's medicinal value in the treatment of hepatitis and liver injury was scheduled to begin in the year 2000. Licorice (Glycyrriza glabra) may also be used for hepatitis. Its properties include protecting the liver and enhancing the immune system. Extended use of licorice should not be undertaken without medical consultation, since potassium deficiency may result.

Vitamin C may be taken as a nutritional supplement. It has been shown to help diminish acute hepatitis and help prevent hepatitis in hospitalized patients. Liver extracts are effective in liver regeneration, and have been used for over a century. Thymus extracts enhance the immune system, which may help the body fight a hepatitis virus.

A practitioner of Chinese herbal medicine may recommend Fructus Schisandrae Chinensis, which improves liver function; Fructus Citrulli Vulgaris, which helps to expel jaundice; or other herbs for hepatitis symptoms.

Allopathic Treatment

A natural body protein, interferon alpha, now can be made in large amounts by genetic engineering, and improves the outlook for many patients who have chronic hepatitis C. The protein can lessen the symptoms of infection and improve liver function. In 2003, a synthetic analogue was added to improve the treatment's effectiveness. Fever and flu-like symptoms are frequent side effects of this treatment. Approximately one-half of patients respond positively to the treatment, although only about 20% receive lasting effects. Several new treatment drugs have been tested and found beneficial in suppressing hepatitis B since early 2003. One of these drugs also helps those patients infected with both hepatitis B and HIV.

When hepatitis destroys most or all of the liver, the only hope may be a liver transplant. However, even when the procedure is successful, disease often recurs and cirrhosis may actually develop more rapidly than before.

Expected Results

Hepatitis a

Most patients with acute hepatitis A, even when severe, begin feeling better in two to three weeks, and recover completely in four to eight weeks. After recovering from hepatitis A, a person no longer carries the virus and remains immune for life. In the United States, serious complications are infrequent and deaths are rare. In the United States, as many as 75% of adults over the age of 50 will have blood test evidence of previous hepatitis A.

Hepatitis B

Each year an estimated 150,000 persons in the United States get hepatitis B. More than 10,000 will require hospital care, and as many as 5,000 will die from complications of the infection. About 90% of those infected will have only acute disease. A large majority of these patients will recover within three months. It is the remaining 10% with chronic infection who account for most serious complications and deaths from HBV infection. In the United States, perhaps only 2% of all infected will become chronically ill. People infected with both HIV and hepatitis B are most likely to die than from either disease alone. Even when no symptoms of liver disease develop, chronic carriers remain a threat to others by serving as a source of infection.

Hepatitis C

In roughly one-fifth of patients who develop hepatitis C, the acute infection will subside, and they will recover completely within four to eight weeks and have no later problems. Other patients face two risks: they themselves may develop chronic liver infection and possibly serious complications such as liver cancer, and they will continue carrying the virus and may pass it on to others. The overall risk of developing cirrhosis is about 15% for all patients infected by HCV. Liver failure is less frequent in patients with chronic hepatitis C than it is for those with other forms of hepatitis. In those people who also have AIDS, hepatitis C infection increases the chance for liver cancer.

Hepatitis D

A large majority of patients with coinfection of HBV and HDV recover from an episode of acute hepatitis. However, about two-thirds of patients chronically infected by HDV go on to develop cirrhosis of the liver. If severe liver failure develops, the chance of a patient surviving is no better than 50%. A liver transplant may improve this figure to 70%.

Hepatitis E

In the United States hepatitis E is not a fatal illness, but elsewhere 1–2% of those infected die of advanced liver failure. In pregnant women the death rate is as high as 20%. It is not clear whether having hepatitis E once guarantees against future HEV infection.

Hepatitis G

What little is known about the course of hepatitis G suggests that illness is mild and does not last long. When more patients have been followed up after the acute phase, it will become clear whether HGV can cause severe liver damage.

Prevention

The best way to prevent any form of viral hepatitis is to avoid contact with blood and other body fluids of infected individuals. The use of condoms during sex also is advisable. Travelers should avoid water and ice if unsure of their purity, or they can boil water before drinking it. All foods eaten should be packaged, well cooked, or, in the case of fresh fruit, peeled. Caution should be exercised when getting tattoos or body piercing, since a 2003 report said that only about one-half of tattoo and piercing shops follow the government's guidelines concerning infection control. These practices can pass hepatitis and HIV infection.

There are vaccines available for both hepatitis A and hepatitis B. Individuals in a high-risk group and travelers should be vaccinated for hepatitis A, and much of the general population can be vaccinated for hepatitis B.

Resources

Books

Fauci, Anthony S. et al., eds. Harrison's Principles of Internal Medicine. 14th edition. New York: McGraw Hill, 1998.

Periodicals

"Antiviral Effective Against Hepatitis B Virus in HIV-Coinfected." Virus Weekly (January 28, 2003): 16.

Bauer, Jeff. "Co-infection with Hepatitis B and HIV Increases Men's Risks of Death from Liver Disease." RN (March 2003): 97.

Eckler, Jody A. Lambright. "Preventing Hepatitis." Nursing 29, no. 8 (August 1999): 66.

Elliott, William T. "Warfarin Effectively Prevents Venous Thromboembolism (Pharmacology Watch)." Critical Care Alert (April 2003).

"Hepatitis C Drug Launched." Chemist and Druggist (January 25, 2003):24.

"Hepatitis C Virus Presents Risk for Liver Cancer in Adults with AIDS." Cancer Weekly (January 7, 2003):35.

"Some Tattoo, Piercing Shops Still Unsafe." AIDS Weekly (March 24, 2003):23.

Organizations

Hepatitis Foundation International. 30 Sunrise Terrace, Cedar Grove, NJ 07009-1423. (800) 891-0707. Fax: (973) 857-5044. http://www.hepfi.org/.

Other

Centers for Disease Control. Hepatitis.http://www.cdc.gov/ncidod/diseases/hepatitis/.

Hep Net: The Hepatitis Information Network.http://www.hepnet.com/.

[Article by: Paula Ford-Martin; Teresa G. Odle]

For more information on hepatitis, visit Britannica.com.

Inflammation of the liver, commonly caused by viruses, but also by alcohol, drugs, and overexposure to toxic chemicals. There are at least three different forms of hepatitis: hepatitis A (infectious hepatitis) is spread via viruses taken in with food and excreted in the faeces; hepatitis B (serum hepatitis) is transmitted sexually, or via infected blood or blood products; and hepatitis C, which is transmitted primarily by blood and blood products. Hepatitis B has been recorded in orienteers who run in woods and brush past undergrowth carrying the virus from an infected person who has been scratched. Rules specifying clothing to be worn in orienteering and other outside sports are aimed at minimizing the risk of these and other diseases (see also Lyme disease). Carriers of the hepatitis B virus are not excluded from sport, but it is important that any injury that causes bleeding is cleaned and secured immediately. Although hepatitis B is a relatively rare infection among athletes, it has a relatively high theoretical risk of transmission; therefore, sensible precautions should be taken and good hygiene practiced.

An inflammation of the liver. Hepatitis is most often caused by a virus, but it can be the result of exposure to certain toxic agents, such as drugs or chemicals. One viral form of the disease is spread by contaminated food and water, and other forms by contaminated injection needles and blood transfusions. Symptoms of hepatitis include fever and jaundice.

Inflammation of the liver which may be toxic or infectious in origin; characterized by signs due to diffuse injury to the liver. See also liver dysfunction. There are a number of etiologically specific hepatitides which are listed under their individual headings. They are avian vibrionic hepatitis, infectious canine hepatitis (see below), infectious necrotic hepatitis, duck hepatitis, turkey hepatitis, inclusion body hepatitis, mouse hepatitis, postvaccinal hepatitis, toxemic jaundice, and those caused by fasciola and fascioloides, cysticercus, and plant toxins including pyrrolizidine alkaloids, sporidesmin, aflatoxin. See also hepatosis dietetica.

• h. A, B, C, D and E viruses — causes of hepatitis in humans and some nonhuman primates.
• avian vibrionic h. — a disease of domesticated poultry which has disappeared from those areas in the USA which were its sole habitat. Vibrio-like organisms were isolated from the outbreaks which occurred.
• cholangiolitic h. — see cholangiohepatitis.
• chronic active h. — a chronic inflammatory liver disease in humans, probably of several types with different causes, but with distinctive histopathological features of piecemeal necrosis, bridging fibrosis and active cirrhosis. A similar, but not identical disease of unknown etiology has been described in dogs.
• copper-induced h. — see bedlington terrier copper-associated hepatopathy.
• duck h. — see duck hepatitis.
• gosling h. — see goose hepatitis.
• infectious canine h. — an acute, highly contagious disease, occurring mainly in young dogs, caused by canine adenovirus type 1. Many dogs experience subclinical infections. Those with clinical signs show fever, depression, vomiting and abdominal pain. The course is short and in severe cases death occurs within a few days. Peracute infections occur in very young puppies. Mild infections may cause only vague signs of malaise and anorexia and many cases are not diagnosed. Dogs recovering from infection sometimes develop corneal edema (‘blue eye’). A chronic hepatitis is reported as an occasional sequela. The disease can be prevented by vaccination.
• mouse h. — a coronavirus disease which causes heavy losses in baby mice. It is characterized by tremor, jaundice and hemoglobinuria.
• mycotic h. — commonly caused in cattle by extension from mycotic rumenitis due to lactic acid indigestion and damage to ruminal epithelium.
• necrotic h. — see infectious necrotic hepatitis.
• porcine h. E virus — an enteric virus of pigs related to human hepatitis E that is not known to be pathogenic.
• toxipathic h. — hepatitis caused by toxins, especially ingested plant toxins, e.g. some pyrrolizidine alkaloids, sporidesmin, aflatoxin.
• trophopathic h. — see trophopathic hepatitis.
• turkey h. — see turkey hepatitis.
• h. X — a hepatoxic disease of dogs and pigs caused by aflatoxins. See also mycotoxicosis.

Hepatitis
Classification and external resources
Alcoholic hepatitis evident by fatty change, cell necrosis, Mallory bodies
ICD-10	K75.9
ICD-9	573.3
DiseasesDB	20061
MeSH	D006505

Hepatitis (plural hepatitides) implies injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ. The name is from ancient Greek hepar (ἧπαρ), the root being hepat- (ἡπατ-), meaning liver, and suffix -itis, meaning "inflammation" (c. 1727)^[1]. The condition can be self-limiting, healing on its own, or can progress to scarring of the liver. Hepatitis is acute when it lasts less than six months and chronic when it persists longer. A group of viruses known as the hepatitis viruses cause most cases of liver damage worldwide. Hepatitis can also be due to toxins (notably alcohol), other infections or from autoimmune process. It may run a subclinical course when the affected person may not feel ill. The patient becomes unwell and symptomatic when the disease impairs liver functions that include, among other things, removal of harmful substances, regulation of blood composition, and production of bile to help digestion.

Contents 1 Causes 1.1 Acute 1.2 Chronic 2 Symptoms 2.1 Acute 2.2 Chronic 3 Types 3.1 Viral 3.2 Other viral causes 3.3 Alcoholic hepatitis 3.4 Drug induced 3.5 Other toxins 3.6 Metabolic disorders 3.7 Obstructive 3.8 Autoimmune 3.9 Alpha 1-antitrypsin deficiency 3.10 Non-alcoholic fatty liver disease 3.11 Ischemic hepatitis 4 See also 5 References 6 External links

Causes

Acute

• Viral hepatitis: Hepatitis A through E (more than 95% of viral cause), Herpes simplex, Cytomegalovirus, Epstein-Barr, yellow fever virus, adenoviruses.
• Non viral infection: toxoplasma, Leptospira, Q fever,^[2] rocky mountain spotted fever^[3]
• Alcohol
• Toxins: Amanita toxin in mushrooms, carbon tetrachloride, asafetida
• Drugs: Paracetamol, amoxycillin, antituberculosis medicines, minocycline and many others (see longer list below).
• Ischemic hepatitis (circulatory insufficiency)
• Pregnancy
• Auto immune conditions, e.g., Systemic Lupus Erythematosus (SLE)
• Metabolic diseases, e.g., Wilson's disease

Chronic

• Viral hepatitis: Hepatitis B with or without hepatitis D, hepatitis C (neither hepatitis A nor hepatitis E causes chronic hepatitis)
• Autoimmune: Autoimmune hepatitis
• Alcohol
• Drugs: methyldopa, nitrofurantoin, isoniazid, ketoconazole
• Non-alcoholic steatohepatitis
• Heredity: Wilson's disease, alpha 1-antitrypsin deficiency
• Primary biliary cirrhosis and primary sclerosing cholangitis occasionally mimic chronic hepatitis^[4]

Symptoms

Acute

Clinically, the course of acute hepatitis varies widely from mild symptoms requiring no treatment to fulminant hepatic failure needing liver transplantation. Acute viral hepatitis is more likely to be asymptomatic in younger people. Symptomatic individuals may present after convalescent stage of 7 to 10 days, with the total illness lasting 2 to 6 weeks.^[4]

Initial features are of nonspecific flu-like symptoms, common to almost all acute viral infections and may include malaise, muscle and joint aches, fever, nausea or vomiting, diarrhea, and headache. More specific symptoms, which can be present in acute hepatitis from any cause, are: profound loss of appetite, aversion to smoking among smokers, dark urine, yellowing of the eyes and skin (i.e., jaundice) and abdominal discomfort. Physical findings are usually minimal, apart from jaundice (33%) and tender hepatomegaly (10%). There can be occasional lymphadenopathy (5%) or splenomegaly (5%).^[5]

Chronic

Majority of patients will remain asymptomatic or mildly symptomatic, abnormal blood tests being the only manifestation. Features may be related to the extent of liver damage or the cause of hepatitis. Many experience return of symptoms related to acute hepatitis. Jaundice can be a late feature and may indicate extensive damage. Other features include abdominal fullness from enlarged liver or spleen, low grade fever and fluid retention (ascites). Extensive damage and scarring of liver (i.e., cirrhosis) leads to weight loss, easy bruising and bleeding tendencies. Acne, abnormal menstruation, lung scarring, inflammation of the thyroid gland and kidneys may be present in women with autoimmune hepatitis.^[6]

Findings on clinical examination are usually those of cirrhosis or are related to etiology.

Types

See also: Infectious canine hepatitis

Viral

Main article: Viral hepatitis

Most cases of acute hepatitis are due to viral infections:

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Hepatitis B with D
• Hepatitis E
• Hepatitis F virus (existence unknown)
• Hepatitis G, or GBV-C
• In addition to the hepatitis viruses (please note that the hepatitis viruses are not all related), other viruses can also cause hepatitis, including cytomegalovirus, Epstein-Barr virus, yellow fever, etc.

Other viral causes

Other viral infections can cause hepatitis (inflammation of the liver):

• Mumps virus
• Rubella virus
• Cytomegalovirus
• Epstein-Barr virus
• Other herpes viruses

Alcoholic hepatitis

Main article: Alcoholic hepatitis

Ethanol, mostly in alcoholic beverages, is a significant cause of hepatitis. Usually alcoholic hepatitis comes after a period of increased alcohol consumption. Alcoholic hepatitis is characterized by a variable constellation of symptoms, which may include feeling unwell, enlargement of the liver, development of fluid in the abdomen ascites, and modest elevation of liver blood tests. Alcoholic hepatitis can vary from mild with only liver test elevation to severe liver inflammation with development of jaundice, prolonged prothrombin time, and liver failure. Severe cases are characterized by either obtundation (dulled consciousness) or the combination of elevated bilirubin levels and prolonged prothrombin time; the mortality rate in both categories is 50% within 30 days of onset.

Alcoholic hepatitis is distinct from cirrhosis caused by long term alcohol consumption. Alcoholic hepatitis can occur in patients with chronic alcoholic liver disease and alcoholic cirrhosis. Alcoholic hepatitis by itself does not lead to cirrhosis, but cirrhosis is more common in patients with long term alcohol consumption. Patients who drink alcohol to excess are also more often than others found to have hepatitis C.^{[citation needed]} The combination of hepatitis C and alcohol consumption accelerates the development of cirrhosis.

Drug induced

Main article: Hepatotoxicity

A large number of drugs can cause hepatitis:^[7]

• Allopurinol
• Amitriptyline (antidepressant)
• Amiodarone (antiarrhythmic)
• Atomoxetine ^[8]
• Azathioprine^[9]
• Halothane (a specific type of anesthetic gas)
• Hormonal contraceptives
• Ibuprofen and indomethacin (NSAIDs)
• Isoniazid (INH), rifampicin, and pyrazinamide (tuberculosis-specific antibiotics)
• Ketoconazole (antifungal)
• Loratadine (antihistamine)
• Methotrexate (immune suppressant)
• Methyldopa (antihypertensive)
• Minocycline (tetracycline antibiotic)
• Nifedipine (antihypertensive)
• Nitrofurantoin (antibiotic)
• Paracetamol (acetaminophen in the United States) can cause hepatitis when taken in an overdose. The severity of liver damage may be limited by prompt administration of acetylcysteine.
• Phenytoin and valproic acid (antiepileptics)
• Troglitazone (antidiabetic, withdrawn in 2000 for causing hepatitis)
• Zidovudine (antiretroviral i.e., against HIV)
• Some herbs and nutritional supplements^[10]

The clinical course of drug-induced hepatitis is quite variable, depending on the drug and the patient's tendency to react to the drug. For example, halothane hepatitis can range from mild to fatal as can INH-induced hepatitis. Hormonal contraception can cause structural changes in the liver. Amiodarone hepatitis can be untreatable since the long half life of the drug (up to 60 days) means that there is no effective way to stop exposure to the drug. Statins can cause elevations of liver function blood tests normally without indicating an underlying hepatitis. Lastly, human variability is such that any drug can be a cause of hepatitis.

Other toxins

Other Toxins can cause hepatitis:

• Amatoxin-containing mushrooms, including the Death Cap (Amanita phalloides), the Destroying Angel (Amanita ocreata), and some species of Galerina. A portion of a single mushroom can be enough to be lethal (10 mg or less of α-amanitin).
• White phosphorus, an industrial toxin and war chemical.
• Carbon tetrachloride ("tetra", a dry cleaning agent), chloroform, and trichloroethylene, all chlorinated hydrocarbons, cause steatohepatitis (hepatitis with fatty liver).
• Cylindrospermopsin, a toxin from the cyanobacterium Cylindrospermopsis raciborskii and other cyanobacteria.

Metabolic disorders

Some metabolic disorders cause different forms of hepatitis. Hemochromatosis (due to iron accumulation) and Wilson's disease (copper accumulation) can cause liver inflammation and necrosis.

Non-alcoholic steatohepatitis (NASH) is effectively a consequence of metabolic syndrome.

Obstructive

"Obstructive jaundice" is the term used to describe jaundice due to obstruction of the bile duct (by gallstones or external obstruction by cancer). If longstanding, it leads to destruction and inflammation of liver tissue.

Autoimmune

Main article: Autoimmune hepatitis

Anomalous presentation of human leukocyte antigen (HLA) class II on the surface of hepatocytes, possibly due to genetic predisposition or acute liver infection; causes a cell-mediated immune response against the body's own liver, resulting in autoimmune hepatitis.

Alpha 1-antitrypsin deficiency

In severe cases of alpha 1-antitrypsin deficiency (A1AD), the accumulated protein in the endoplasmic reticulum causes liver cell damage and inflammation.

Non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is the occurrence of fatty liver in people who have no history of alcohol use. It is most commonly associated with obesity (80% of all obese people have fatty liver). It is more common in women. Severe NAFLD leads to inflammation, a state referred to as non-alcoholic steatohepatitis (NASH), which on biopsy of the liver resembles alcoholic hepatitis (with fat droplets and inflammatory cells, but usually no Mallory bodies).

The diagnosis depends on medical history, physical exam, blood tests, radiological imaging and sometimes a liver biopsy. The initial evaluation to identify the presence of fatty infiltration of the liver is medical imaging, including such ultrasound, computed tomography (CT), or magnetic resonance (MRI). However, imaging cannot readily identify inflammation in the liver. Therefore, the differentiation between steatosis and NASH often requires a liver biopsy. It can also be difficult to distinguish NASH from alcoholic hepatitis when the patient has a history of alcohol consumption. Sometimes in such cases a trial of abstinence from alcohol along with follow-up blood tests and a repeated liver biopsy are required.

NASH is becoming recognized as the most important cause of liver disease second only to hepatitis C in numbers of patients going on to cirrhosis.^{[citation needed]}

Ischemic hepatitis

See also: Ischemic hepatitis

Ischemic hepatitis is caused by decreased circulation to the liver cells. Usually this is due to decreased blood pressure (or shock), leading to the equivalent term "shock liver". Patients with ischemic hepatitis are usually very ill due to the underlying cause of shock. Rarely, ischemic hepatitis can be caused by local problems with the blood vessels that supply oxygen to the liver (such as thrombosis, or clotting of the hepatic artery which partially supplies blood to liver cells). Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT), which may exceed 1000 U/L. The elevation in these blood tests is usually transient (lasting 7 to 10 days). It is rare that liver function will be affected by ischemic hepatitis.

See also

• World Hepatitis Day
• Hepatocellular carcinoma

References

1. ^ Online Etymology Dictionary [1]
2. ^ Figure 7.12 (Some causes of acute parenchymal damage), Parveen, M.D. Kumar (Editor), Michael, M.d. Clark (Editor) (2005). Clinical Medicine: with STUDENT CONSULT Access. Philadelphia, PA: W.B. Saunders Company. ISBN 0-7020-2763-4. 
3. ^ Scott Moses, MD, Acute Hepatitis causes, Family practice notebook.com
4. ^ ^{a b} V.G. Bain and M. Ma, Acute Viral Hepatitis, Chapter 14, First principle of gastroenterology (an online text book)
5. ^ Ryder S, Beckingham I (2001). "ABC of diseases of liver, pancreas, and biliary system: Acute hepatitis". BMJ 322 (7279): 151–153. doi:10.1136/bmj.322.7279.151. PMID 11159575. 
6. ^ Chronic hepatitis at Merck Manual of Diagnosis and Therapy Home Edition
7. ^ "Hepatitis as a result of chemicals and drugs". HealthAtoZ. http://www.healthatoz.com/healthatoz/Atoz/dc/caz/infc/hepa/hepres.jsp. Retrieved on 2006-07-01. 
8. ^ Lim JR, Faught PR, Chalasani NP, Molleston JP (2006). "Severe liver injury after initiating therapy with atomoxetine in two children". J. Pediatr. 148 (6): 831–4. doi:10.1016/j.jpeds.2006.01.035. PMID 16769398. 
9. ^ Bastida G, Nos P, Aguas M, Beltrán B, Rubín A, Dasí F, Ponce J (2005). "Incidence, risk factors and clinical course of thiopurine-induced liver injury in patients with inflammatory bowel disease". Aliment Pharmacol Ther 22 (9): 775–82. doi:10.1111/j.1365-2036.2005.02636.x. PMID 16225485. 
10. ^ Nadir A, Reddy D, Van Thiel DH (2000). "Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity". Am. J. Gastroenterol. 95 (12): 3634–7. doi:10.1111/j.1572-0241.2000.03386.x. PMID 11151906. 

External links

• WHO fact sheet of hepatitis
• Viral Hepatitis at the Centers for Disease Control

v • d • e Digestive system · Digestive disease · Gastroenterology (primarily K20-K93, 530-579) Upper GI tract Esophagus Esophagitis (Candidal) · rupture (Boerhaave syndrome, Mallory-Weiss syndrome) · UES (Zenker's diverticulum) · LES (Barrett's esophagus) · Esophageal motility disorder (Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD) · Esophageal stricture · Megaesophagus Stomach Gastritis (Atrophic, Ménétrier's disease, Gastroenteritis) · Peptic (gastric) ulcer (Cushing ulcer, Dieulafoy's lesion) · Dyspepsia · Pyloric stenosis · Achlorhydria · Gastroparesis · Gastroptosis · Portal hypertensive gastropathy · Gastric antral vascular ectasia · Gastric dumping syndrome · Gastric volvulus Intestinal/ enteropathy Small intestine/ (duodenum/jejunum/ileum) Enteritis (Duodenitis, Jejunitis, Ileitis) — Peptic (duodenal) ulcer (Curling's ulcer) — Malabsorption: Coeliac · Tropical sprue · Blind loop syndrome · Whipple's · Short bowel syndrome · Steatorrhea · Milroy disease Large intestine (appendix/colon) Appendicitis · Colitis (Pseudomembranous, Ulcerative, Ischemic, Microscopic, Collagenous, Lymphocytic) · Functional colonic disease (IBS, Intestinal pseudoobstruction/Ogilvie syndrome) — Megacolon/Toxic megacolon · Diverticulitis/Diverticulosis Large and/or small Enterocolitis (Necrotizing) · IBD (Crohn's disease) — vascular: Abdominal angina · Mesenteric ischemia · Angiodysplasia — Bowel obstruction: Ileus · Intussusception · Volvulus · Fecal impaction — Constipation · Diarrhea (Infectious) Rectum Proctitis (Radiation proctitis) · Proctalgia fugax · Rectal prolapse Anus Anal fissure/Anal fistula · Anal abscess  · Anal dysplasia  · Pruritus ani Accessory Liver Hepatitis (Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis) · Cirrhosis (PBC) · Fatty liver (NASH) · vascular (Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver) · Alcoholic liver disease · Liver failure (Hepatic encephalopathy, Acute liver failure) · Liver abscess (Pyogenic, Amoebic) · Hepatorenal syndrome · Peliosis hepatis Gallbladder Cholecystitis · Gallstones/Cholecystolithiasis · Cholesterolosis · Rokitansky-Aschoff sinuses · Postcholecystectomy syndrome Bile duct/ other biliary tree Cholangitis (PSC, Secondary sclerosing cholangitis, Ascending) · Cholestasis/Mirizzi's syndrome · Biliary fistula · Haemobilia · Gallstones/Cholelithiasis common bile duct (Choledocholithiasis, Biliary dyskinesia) Pancreatic Pancreatitis (Acute, Chronic, Hereditary) · Pancreatic pseudocyst · Exocrine pancreatic insufficiency · Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic · Hiatus — Abdominal hernia: Inguinal (Indirect, Direct) · Umbilical · Incisional · Femoral — Obturator hernia · Spigelian hernia · Internal hernia Peritoneal Peritonitis (Spontaneous bacterial peritonitis) · Hemoperitoneum · Pneumoperitoneum GI bleeding/BIS Upper (Hematemesis, Melena) · Lower (Hematochezia) See also: congenital and neoplasia

v • d • e Inflammation Acute Plasma derived mediators Bradykinin · complement (C3, C5a, MAC) · coagulation (Factor XII, Plasmin, Thrombin) Cell derived mediators preformed: Lysosome granules · vasoactive amines (Histamine, Serotonin) synthesized on demand: cytokines (IFN-γ, IL-8, TNF-α, IL-1) · eicosanoids (Leukotriene B4, Prostaglandins) · Nitric oxide · Kinins Chronic Macrophage · Epithelioid cell · Giant cell · Granuloma Processes Traditional: Rubor · Calor · Tumor · Dolor (pain) · Functio laesa Modern: Acute-phase reaction/Fever · Vasodilation · Increased vascular permeability · Exudate · Leukocyte extravasation · Chemotaxis Specific types Nervous CNS (Encephalitis, Myelitis) · Meningitis (Arachnoiditis) · PNS (Neuritis) · eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis) · ear (Otitis, Labyrinthitis, Mastoiditis) Cardiovascular Carditis (Endocarditis, Myocarditis, Pericarditis) · Vasculitis (Arteritis, Phlebitis, Capillaritis) Respiratory upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis) · lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis) · Mediastinitis Digestive mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis) · tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis) · accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis) · Peritonitis Integumentary Dermatitis (Folliculitis) · Hidradenitis Musculoskeletal Arthritis · Dermatomyositis · soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis) Osteochondritis: Osteitis (Spondylitis, Periostitis) · Chondritis Urinary Nephritis (Glomerulonephritis, Pyelonephritis) · Ureteritis · Cystitis · Urethritis Reproductive female: Oophoritis · Salpingitis · Endometritis · Parametritis · Cervicitis · Vaginitis · Vulvitis · Mastitis male: Orchitis · Epididymitis · Prostatitis · Balanitis · Balanoposthitis pregnancy/newborn: Chorioamnionitis · Omphalitis Endocrine Insulitis · Hypophysitis · Thyroiditis · Parathyroiditis · Adrenalitis

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Dansk (Danish)
n. - leverbetændelse, hepatitis

Nederlands (Dutch)
hepatitis, ontsteking van de lever

Français (French)
n. - hépatite

Deutsch (German)
n. - Hepatitis, Leberentzündung

Ελληνική (Greek)
n. - (παθολ.) ηπατίτιδα

Italiano (Italian)
epatite

Português (Portuguese)
n. - hepatite (f) (Med.)

Русский (Russian)
гепатит

Español (Spanish)
n. - hepatitis

Svenska (Swedish)
n. - hepatit (inflammation i levern)

中文（简体）(Chinese (Simplified))
肝炎

中文（繁體）(Chinese (Traditional))
n. - 肝炎

한국어 (Korean)
n. - 간염

日本語 (Japanese)
n. - 肝炎

العربيه (Arabic)
‏(الاسم) مرض التهاب الكبد‏

עברית (Hebrew)
n. - ‮דלקת הכבד, צהבת‬

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